Factors associated with chronic headache among adults: results from a Ravansar noncommunicable disease cohort study.

Background: Headache is the most common disorder of the central nervous system, and one of the most prevalent noncommunicable diseases. Aims: We aimed to determine factors associated with chronic headache among adults in the Islamic Republic of Iran. Methods: This was a cross-sectional study that recruited 10 063 participants from the baseline data of the Ravansar noncommunicable disease cohort study in western Islamic Republic of Iran in 2021. Participants who had headaches for ≥ 15 days per month for ≥ 3 months were considered as having chronic headache. Logistic regression was used to examine the associations. Results: The prevalence of chronic headache was 10.49% (n = 1054), and was significantly higher among females (14.55%, n = 769) than males (5.98%, n = 285) (P < 0.001). The risk of chronic headache among married females was 73% higher than among single females. Among male smokers, the risk of chronic headache was 1.47 times higher than among non-smokers [95% confidence interval (CI): 1.05, 2.06]. The risk of chronic headache among depressed males was 2.59 times higher than among non-depressed males (95% CI: 1.28, 5.22); and among depressed females the risk was 2.38 times higher than among non-depressed females (95% CI: 1.76, 3.23). Among males who lived in rural areas, the risk of chronic headache was 84% lower than among those who lived in urban areas; and among females who lived in rural areas it was 81% lower than those who lived in urban areas. Being menopausal and having normal sleep were significantly associated with lower risk, while comorbidity was associated with higher risk, of developing chronic headache. Conclusions: Depression, urban residence, smoking, comorbidity, and being married were associated with an increase in the risk of developing chronic headache, while higher education level, menopause and normal sleep were associated with a decrease in the risk of developing chronic headache.

A Comprehensive Evaluation of Occupational Epidemiology in Western Iran: A Cohort Study in Ravansar Noncommunicable Diseases.

OBJECTIVE: The present study aims to evaluate the prevalence of noncommunicable diseases (NCDs), biochemical and anthropometric indicators, and lifestyle among 10 occupational groups. METHOD: The sample included 4818 men aged 35 to 65 years. The occupational group is based on the International Standard Classification of Occupations. RESULT: The highest prevalence of cardiovascular diseases and type 2 diabetes mellitus was observed in managerial occupational groups (18.62%) and technicians and associate professionals ( 14 %), respectively. Musculoskeletal disorders were more in skilled agricultural, forestry, and fishery workers, as well as craft-related trades workers, and elementary occupations. The highest body mass index was related to the managers. CONCLUSIONS: Noncommunicable diseases were higher in managers, while musculoskeletal disorders belonged to farmers and workers. Finally, lifestyle modification can help reduce NCDs and improve biochemical markers by increasing physical activity.

Effectiveness of oral levamisole as an adjuvant to hepatitis B vaccination in healthcare workers non-responsive to previous vaccination: A randomized controlled trial.

Background: Healthcare workers are at risk for HBV infection through percutaneous or mucosal contact with infected blood, body secretions, or blood products or via sharps injury. Hepatitis B vaccination, despite immunogenicity, may not induce a proper immune response in 5-10% of the general adult population. Increased immune response in healthcare providers that do not respond properly to conventional hepatitis B vaccination is an important health challenge. Therefore, the aim of the present study was to evaluate the effectiveness of hepatitis B vaccination plus oral levamisole as adjuvant in healthcare providers non-responsive to routine vaccination. Materials and methods: The healthcare workers that were non-responsive to previous hepatitis B vaccination were enrolled in a double-blind randomized placebo-controlled clinical trial. The participants were then randomized to two groups including hepatitis B vaccination (as a three-dose series on a 0, 1, and 2-month schedule in the deltoid muscle) plus levamisole (levamisole group) and hepatitis B vaccination plus placebo (placebo group) at a 1:1 ratio. The outcome measure was the HBs antibody titer one month after receiving each dose as well as the seroprotection ratio. The side effects were also evaluated in all participants. Results: In total, 22 subjects finished the trial (11 individual in per group). The median antibody titer one month after receiving the first and third doses increased more in the levamisole group compared to the placebo group but the difference was not significant (p â€‹= â€‹0.34, p â€‹= â€‹0.66, respectively).The seroprotection ratio after three doses was similarly high in both groups (90.9% in per group). Furthermore, the seroprotection ratio and median antibody titer had no significant correlation with age, sex, BMI, and history of smoking in intervention and control groups (p>0.05). No serious side effects were noted in both groups. Conclusions: Re-vaccination can boost the immune response in healthcare professionals that were non-responsive to previous vaccination although the mean antibody titer was higher in the levamisole group.

Efficacy of stereotactic radiosurgery as single or combined therapy for brain metastasis: A systematic review and meta-analysis.

To determine the efficacy of stereotactic radiosurgery (SRS) in treating patients with brain metastases (BMs), a network meta-analysis (NMA) of randomized controlled trials (RCTs) and a direct comparison of cohort studies were performed. Relevant literature regarding the effectiveness of SRS alone and in combination with whole-brain radiotherapy (WBRT) and surgery was retrieved using systematic database searches up to April 2019. The patterns of overall survival (OS), one-year OS, progression-free survival (PFS), one-year local brain control (LBC), one-year distant brain control (DBC), neurological death (ND), and complication rate were analyzed. A total of 18 RCTs and 37 cohorts were included in the meta-analysis. Our data revealed that SRS carried a better OS than SRS+WBRT (p = 0.048) and WBRT (p = 0.041). Also, SRS+WBRT demonstrated a significantly improved PFS, LBC, and DBC compared to WBRT alone and SRS alone. Finally, SRS achieved the same LBC as high as surgery, but intracranial relapse occurred considerably more frequently in the absence of WBRT. However, there were not any significant differences in ND and toxicities between SRS and other groups. Therefore, SRS alone may be a better alternative since increased patient survival may outweigh the increased risk of brain tumor recurrence associated with it.

Comparing the Associated Factors on Lifestyle Between Type 2 Diabetic Patients and Healthy People: A Case-Control Study.

BACKGROUND: the most important way to control diabetes is to follow a preventive lifestyle and if a diabetic individual follows a preventive lifestyle which he or she has accepted. The main objective of the current study is to compare the factors affecting the lifestyle in patients suffering from Type II diabetes and the healthy individuals in Kermanshah City. METHODS: this study is based on a case-control design where using simple random sampling, 110 patients suffering from type II diabetes are selected as the case group and 111 healthy subjects among the companions of other patients are selected as the control group from the Center for Diabetics in Kermanshah City. The average age of the participants is 48.8±11.0. The questionnaires used for collecting the data included the following: the demographic information questionnaire and the lifestyle questionnaire which covers diet, physical activity, coping with stress, and smoking. Software applications including STSTA14 and SPSS23 were used for performing statistical computations and logistic regression or linear regression tests were used for analyzing the collected data. RESULTS: in the subscales of diet, physical activity, spiritual growth, and stress management, there was a significant difference between the diabetic and healthy groups in a wat that the average score for these subscales was higher in the healthy individuals. While the average score for "health responsibility" was higher in the diabetic group compared to the healthy subjects, the difference was not significant (P<0.232). Moreover, there was a significant statistical relationship between the two groups, i.e. the diabetic and healthy groups, and the variables of age, education level, and occupation (P > 0.05). CONCLUSION: healthy lifestyle including proper diet and athletic activity is effective in preventing type II diabetes. Accordingly, implementing policies in the urban transportation system such as providing a special lane for bikers in the cities, increasing the tax for harmful foods, considering subsidies for healthy food products, and self-care of individuals can be effective.

Stereotactic radiosurgery with immune checkpoint inhibitors for brain metastases: a meta-analysis study.

BACKGROUND: Immune checkpoint inhibitors (ICIs) are an emerging tool in the treatment of brain metastases (BMs), Stereotactic radiosurgery (SRS), traditionally used for BMs, elicits an immune brain response and can act synergistically with ICIs. We aim to investigate the efficacy of ICI administered with SRS and determine the impact of timing on BM response. METHODS: A systematical search was performed to identify potential studies concerning BMs managed with SRS alone or with SRS + ICI with relative timing administration (ICI concurrent with SRS, ICI nonconcurrent with SRS, SRS before ICI, SRS after ICI). The overall survival (OS), 12-month OS, local progression-free survival (LPFS), 12-month local brain control (LBC), distant progression-free survival (DPFS), 12-month distant brain control (DBC), and adverse events (intracranial hemorrhage, radionecrosis) were analyzed using the random-effects model. RESULTS: A total of 16 retrospective studies with 1356 BM patients were included. Compared to nonconcurrent therapy, concurrent therapy revealed a significantly longer OS (HR= 1.43; p = 0.008) and 12-months LBC (HR = 1.91; p = 0.04), a similar 12-months DBC (HR = 1.12; p = 0.547) and higher complication rate (R = 0.77; p = 0.346). Concurrent therapy leads to a significantly higher OS compared to ICI before SRS (HR = 2.55; p = 0.0003). CONCLUSION: The combination of SRS with ICI improves patients' clinical and radiological outcomes. The effectiveness of the combination is subject to the identification of an optimal therapeutic window.

Factors Associated with Infant Mortality Due to Congenital Anomalies: A Population-Based Case-Control Study.

Background: Congenital anomalies are one of the major public health problems and one of the leading cause of infant mortality and morbidity. We aimed to investigate some factors associated with infant mortality due to congenital anomalies in several provinces of Iran. Methods: This case-control study was conducted on 2199 women referring health centers of nine provinces of Iran 2015-2018. Cases were defined as mothers with infant death due to congenital anomalies, and control group comprised of mothers with live birth or infant deaths due to other causes (n=1986). The descriptive data were expressed as percentage and frequency. Factors associated with infant death due to congenital anomalies were evaluated and analyzed at 95% confidence level by logistic regression analysis. Results: The multiple logistic regression analysis reveal that history of cesarean delivery [OR:2.13 ;95%CI (1.58-2.87)], maternal age [OR:1.94 ;95%CI (1.31-2.86)])], area of living [OR: 1.69;95%CI (1.22-2.33)], maternal smoking during pregnancy [OR: 1.41; 95%CI (1.02-1.95)], consanguineous marriage [OR:1.53;95%CI (1.12-2.08)], also low birth weight [OR: 3.09; 95%CI (2.23-4.30)] were significantly associated with infant death due to congenital anomalies. Conclusion: Identification of factors associated with congenital anomalies has been shown to reduce treatment costs and medical complications of neonates. Therefore, genetic counseling and educational programs for high-risk women, and prenatal screening are essential to identify and prevent factors contributing to congenital abnormalities.

Care burden and associated factors in caregivers of children with cancer.

BACKGROUND: Evidence suggests that many parents who care for their children with cancer are affected by the care burden due to the chronic nature of the disease. The aim of this study was to determine the burden of care level and its related factors in the caregivers of children with cancer. METHOD: A total of 270 caregivers of children with cancer were included in this cross-sectional study by convenience sampling method. Data collection tools were a personal information form and the Novak & Guest's Caregiver Burden Inventory. Data were analyzed by descriptive and inferential statistics (chi-square and univariate linear regression model). RESULTS: The mean ages of caregivers and patients were 35.7 ± 7.0 and 3.1 ± 1.6 years, respectively. The mean care burden was 68.4 ± 1.5 out of 120. About 50 and 36% of caregivers had moderate and severe care burden, respectively. CONCLUSION: Caregivers had moderate to high care burden. A number of factors associated with care burden were identified. Health authorities need to take family-centered measures to reduce the burden of caregivers.

Quality of life and related factors in caregivers of children with cancer in Iran.

PURPOSE: The aim of this study was to determine the quality of life and its related factors in the caregivers of children with cancer. METHODS: This cross-sectional study assessed the quality of life of 270 caregivers of children with cancer in Iran. Data collection tools were a personal information form and the Caregiver Quality of Life Index-Cancer. Data were analyzed by SPSS-18 software using descriptive and inferential statistics (independent t-test, analysis of variance, and linear regression model). RESULTS: The mean score of quality of life was 78.3 ± 1.6 out of 140. Variables that were significantly associated with quality of life included age (p = .031), gender (p = .021), education (p = .048), occupation (p = .011), economic status (p = .038), average caring time (p = .021), and age of the child (p = .011). CONCLUSION: The caregivers of children with cancer did not have a good quality of life. Healthcare providers need to provide comprehensive educational, emotional, social, and economic support to the caregivers of patients with cancer.

The Association of Dietary Total Antioxidant Capacity with Inflammatory Biomarkers and Anthropometric Indices in Patients Who Candidate for Coronary Artery Bypass Graft Surgery: a Cross-sectional Study.

Antioxidant compounds can attenuate inflammation and delay degenerative processes especially in the cardiovascular system. This study aimed to determine the relationship between dietary total antioxidant capacity (DTAC) and serum biomarkers in patients undergoing coronary artery bypass graft surgery. In this cross-sectional study, 146 patients who had referred to Imam Ali Hospital in Kermanshah were recruited and demographic, anthropometric, physical activity and dietary data were collected. Fasting blood glucose (FBG), serum levels of lipid profile, inflammatory markers (interleukin [IL]-17, intercellular and vascular cell adhesion molecules [ICAM, VCAM]), and total antioxidant capacity (TAC) were also measured. A regression model adjusted for confounding variables presented that the coefficients of ICAM and VCAM (ng/dL) in the third tertile of DTAC were lower than those in the first tertile (ß = -417.2, 95% confidence interval [CI] = -509.9 to -324.5, p < 0.001; ß = -293.2, 95% CI = -334.3, -252.1, p < 0.001, respectively). The ß of serum TAC (ng/dL) in the third tertile was 0.86 (95% CI = 0.77, 0.95, p < 0.001) higher than that in the first tertile. DTAC had no statistically significant relationship with lipid profile, FBG, and IL-17 levels, and anthropometric indices. In this study DTAC was associated with increased serum TAC and decreased cell adhesion molecules. Therefore, diet antioxidants may be beneficial in attenuating of inflammation in coronary artery diseases.

Socioeconomic inequality in noncommunicable diseases: Results from a baseline Persian cohort study.

Background: Contrary to health indices advancement during recent years, health inequalities are still a global challenge. This study aimed to determine socioeconomic factors for noncommunicable diseases using concentration indices (CI). Methods: This cross-sectional study was conducted on the baseline data from a cohort study in Fasa (southern Iran). Principle component analysis was used to measure asset index. Moreover, socioeconomic inequalities were calculated by CI. Analysis was done at 95% confidence level using STATA software. Results: A total of 7990 individuals were included in the study. The highest negative CIs were significantly found for epilepsy (-0.334), paramnesia (-0.255), and learning disabilities (-0.063), respectively, and the lowest were significantly found for chronic headaches (-0.046), recurrent headaches (-0.03), infertility (-0.028) and hypertension (-0.057). This index was positive for breast cancer (0.298). Furthermore, it was not Significant for diabetes, thyroid disorders, depression, and chronic lung diseases. Conclusion: The findings showed a significant inequality in the most of the noncommunicable diseases in the region, which are more concentrated among the poorest population. Policymakers in the health system and city planners should consider these results to decrease the burden of noncommunicable diseases in the society by identifying vulnerable subcategories.

Effects of vitamin D supplementation on core symptoms, serum serotonin, and interleukin-6 in children with autism spectrum disorders: A randomized clinical trial.

OBJECTIVES: Children with autism spectrum disorders (ASD) have lower serum vitamin D and higher serotonin and interleukin (IL)-6 levels compared with healthy children. The aim of this study was to evaluate the effect of vitamin D on core symptoms and serum levels of serotonin and IL-6 in these children. METHODS: This parallel randomized double-blind, placebo-controlled trial was conducted with 43 children with ASD (7 girls and 36 boys; 8.91 ± 2.87 y of age). Children were randomly allocated to receive either vitamin D drop (300 IU/kg up to a maximum of 6000 IU daily) or placebo for 15 wk. Serum levels of 25-hydroxyvitamin (OH)D, IL-6, and serotonin were measured at baseline and at the end of the trial. Also, the severity of autism and the social and individual maturity of the children were measured by the Childhood Autism Rating Scale (CARS), the Autism Treatment Assessment Checklist (ATEC), and Aberrant Behavior Checklist-Community (ABC-C) questionnaires before and after intervention. Randomization and allocation to groups were done using computer-generated numbers. RESULTS: More than 86% of patients had vitamin D deficiency at the beginning of the study. Serum levels of 25(OH)D increased significantly in the vitamin D group (P = 0.001). The clinical symptoms of autism measured by CARS and ATEC scales were alleviated significantly (P = 0.021 and P = 0.020, respectively); however, the serum levels of serotonin and IL-6 and the scale of ABC-C remained without a significant change. CONCLUSION: These findings suggest that vitamin D supplementation may improve ASD symptoms; however, more studies with longer duration are indispensable to confirm our results.

Dietary Patterns and Risk of Invasive Ductal and Lobular Breast Carcinomas: A Systematic Review and Meta-analysis.

The histopathologic subtypes of breast cancer, including invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC), differ in terms of risk factors, progression, and response to treatment. The PubMed/Medline, Web of Science, and Scopus databases were searched up to February 2020 for published studies on the association between dietary patterns (Western diet [WD] or Mediterranean diet [WD]) and the risk of IDC/ILC of breast. Multivariable adjusted relative risk (RR) and 95% confidence intervals (CIs) comparing the highest and lowest categories of WD and MD patterns were combined by using the random-effects meta-analyses. After searching the databases, 10 eligible studies on the association of diet and IDC (7 articles) and ILC (3 articles) were included in the analysis. A statistically significant adverse association was observed between MD and IDC in case-control studies (RR = 0.47; 95% CI, 0.39-0.55; I2 = 85.1%; P < .001). However, the association was nonsignificant in cohort studies (RR = 0.98; 95% CI, 0.92-1.05; I2 = 88.8%; P = .003). The pooled analysis also suggested a significant and direct association between the WD and the risk of IDC (RR = 1.36; 95% CI, 1.18-1.53; I2 = 63.7%; P = .017). The risk of ILC for the highest compared to the lowest category of MD was highly protective (RR = 0.76; 95% CI, 0.64-0.87; I2 = 89.2%; P < .001), and a marginally significant association was found between the WD and risk of ILC (RR = 1.45; 95% CI, 1.04-1.86), with no heterogeneity (I2 = 0; P = .52). This meta-analysis provides supporting evidence for the association between MD decreased risk of IDC and ILC of the breast and the association between WD and increased risk of IDC and ILC. Further investigations are needed to better understand the reasons behind the etiologic mechanisms of how dietary patterns affect patients differently by common breast cancer subtypes, including IDC and ILC.

Factors associated with overweight and obesity in adults using structural equation model: mediation effect of physical activity and dietary pattern.

PURPOSE: This study aimed to determine the indirect effect of risk factors associated with overweight and obesity through physical activity (PA) and dietary pattern (DP), using structural equation model in the adults' population. METHODS: This cross-sectional study was conducted on 10,000 adults from baseline data of Ravansar Non Communicable Disease cohort study, in the west region of Iran in 2018. Structural equation modeling was used to assess the causal effects of associated factors on obesity and overweight as the outcome. RESULTS: In general, the population at higher economic level was significantly more dependent on the healthy DP. The direct effect of socioeconomic status (SES) on overweight and obesity was - 0.070, the indirect effect was 0.127, and the total effect was 0.057. When stratified by gender, in women, SES had a weak direct effect (ß = 0.024) and indirectly, through the variables of PA and DP, had a significant effect (ß = 0.088) on the outcome. The same situation has been observed in men. That is a weak direct effect of SES (ß = 0.070) and a significantly indirect effect, through three variables such as PA, DP, and smoking status, on the outcome. CONCLUSION: Factors associated with overweight and obesity not only by direct effect, but also can indirectly and through mediators (such as DP and PA as two important mediation variables) cause this outcome. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Survival Rate of Breast Cancer in Eastern Mediterranean Region Countries: A Systematic Review and Meta-Analysis.

Background: Breast cancer (BC) is one of the main problems of public health around the world. As a consequence, survival rates are one of the most salient indicators for assessing the quality of cancer control and treatment programs. Objectives: The aim of this study is to evaluate the survival rate of breast cancer in the Eastern Mediterranean region at different periods of time. Methods: Medline/PubMed, ProQuest, Scopus, Embase, Web of Knowledge and Google Scholar databases until February 1, 2018. All observational studies (cross-sectional, case-control, and cohort) referring to the survival of breast cancer were included in the study. The heterogeneity and its value were examined by Cochran test and I2 statistics, respectively. Analysis of subgroups performed was based on geographical area and Human Development Index (HDI), using Stata 12 software. Findings: A total of 58 papers were analyzed. Based on a random effect model, the survival rates of breast cancer in different periods-1, 2, 3, 4, 5 and 10 years-were estimated at 93.9, 85, 79.8, 72.6, 69.2, 62.1 and 55.5 percent, respectively. The highest 10-year survival rate was in Iran (59.2%), and the lowest was observed in Bahrain (45%). Conclusions: Evidence suggests that about half of the patients in this area would die before 10 years survival, which is different from more developed countries. Also, high survival rates are associated with high human development index, which can help health policy-makers to better predict the outcomes of patients.

Prevalence and risk factors associated with human cystic echinococcosis in Iran.

Cystic echinococcosis (CE), as a zoonotic helminthic infection, imposes a large socioeconomic burden to societies throughout the world. This study aimed to analyze the demographic, clinical, diagnostic and therapeutic data of CE patients across all provinces in Iran. In this cross-sectional study, the mentioned data were routinely collected by provincial medical universities during the time from March 2016 to March 2017. The provincial population census was used to calculate the prevalence of CE per 1,000,000 populations for all provinces. T test and Chi squared test were used to compare variables between genders. Statistical analysis was done at 95% significant level using STATA 14 software. The overall prevalence of CE was 6.8 cases per 1,000,000 populations in Iran. The highest and lowest prevalence was reported for Northeast (15.2) and southeast (0.7) of Iran, respectively. There was a significant difference in the prevalence between male and female (5.8 vs. 7.9, p < 0.001). An increasing trend of the prevalence was found by age in both males and females. Abdominal pain was reported as the highest proportion of symptom (39.0%) and the liver was a commonly infected organ (62.7%). CT scan (39.0%) and MRI (1.9%) had the highest and lowest proportion among types of CE diagnosis, respectively. About 67% of the patients washed the vegetable by water without any disinfectant. Due to global efforts on the control and prevention of CE, it still remains endemic in many countries throughout the world. Incidence trend of CE in Iran showed being endemic for CE and more investigations are needed on all aspects of the disease.

Associations between Muscle Strength with Different Measures of Obesity and Lipid Profiles in Men and Women: Results from RaNCD Cohort Study.

We aimed to examine associations between muscle strength and obesity and serum lipid profile in Ravansar Non-Communicable Disease (RaNCD) cohort study. This study was conducted on 6,455 subjects aged 35-65 years old from baseline data of RaNCD in Iran. The associations between grip strength and adiposity measurements were explored using linear regression with adjustment for age, height, smoking status, alcohol intake, social class, and prevalent disease. The mean of body mass index (BMI) and muscle strength was 27.2 ± 4.6 kg/m2 and 33.3 ± 11.5, respectively. Muscular strength increased with increasing BMI and waist circumference (WC) in both sexes. Multivariate regression analysis revealed a 3.24 (95% confidence interval [CI], 2.29, 4.19) kg difference between BMI in top and bottom in men, and 1.71 (95% CI, 0.98, 2.34) kg/m2 in women. After multivariable adjustment, a difference of 2.04 (95% CI, 1.12, 2.97) kg was observed between the top and bottom WC quartiles in men and 1.25 (95% CI, 0.51, 1.98) kg in women. In men, with increase of low-density lipoprotein and cholesterol, the mean muscle strength was significantly increased. Muscle strength may be associated with body composition and lipid profiles. Muscle strength can be an appropriate indicator for predicting some of the problems caused by body composition disorders, which requires further longitudinal studies.

Impact of Smoking on Health-Related Quality of Life: A General Population Survey in West Iran

This study was aimed at assessing any association between smoking and health-related quality of life (HRQoL) among adults aged 18 years and above living in Kermanshah city, western Iran. A cross-sectional study was conducted on a total sample of 1,543 participants obtained by convenient sampling during the period from February 1st to May 30th, 2017. Data were collected using a self-administrated questionnaire. The HRQoL of the study participants was assessed with reference to the EuroQol 5-dimensions-3-level (EQ-5D-3L). The impact of smoking behavior of the participants on HRQoL with controls for potential confounders was examined by multiple regression. Out of the total of 1,543 participants, current smokers, past smokers, and never smokers accounted for 19.7%, 4.2% and 76.1%, respectively. The mean EQ-5D indices were 0.69 ±SD 0.20, 0.70 ± SD 0.22, and 0.78 ± SD 0.16. The highest proportion of self-reported problems (including both 'some' and 'severe') were related to current, heavy smokers, with high nicotine dependence. Regression analysis indicated that current smokers had a significantly lower HRQoL compared to past smokers and never smokers (p < 0.05). The heavy smokers also had a significantly lower HRQoL score than moderate and light smokers (p < 0.05) and there was an inverse relationship between the HRQoL score and nicotine dependence (p<0.05). The current smokers, heavy smokers, and high nicotine dependent smokers had lower HRQoL scores. These findings provide inputs for better understanding and for devising interventions for smoking cessation, reducing the number of cigarettes smoked per day and nicotine dependency.

Determinants of health-related quality of life in Iranian adults: evidence from a cross-sectional study.

OBJECTIVES: This study aimed to measure the level and determinants of health-related quality of life (HRQoL) in adults in Kermanshah, a city in the western region of Iran. METHODS: Convenience sampling was employed to obtain a sample of 998 adults aged 18 years and older (646 males and 352 females) in the city of Kermanshah. A 2-part self-administered questionnaire was used to collect data over the period between March 1 and May 30, 2017. The first part was designed to collect information on socio-demographic characteristics, socioeconomic status, and lifestyle factors (10 items). The second part consisted of the EuroQoL 5-dimensions (EQ-5D) EuroQoL-3-level and the EuroQoL visual analog scale (EQ-VAS) questions. A multiple linear regression model was used to determine the factors associated with the EQ-5D index and EQ-VAS score among study participants. RESULTS: The mean values for the EQ-5D index and the EQ-VAS score were 0.74 (standard deviation [SD], 0.19) and 80.9 (SD, 16.5), respectively. The highest percentage of self-reported problems ('some' and 'severe' problems) across the 5 dimensions of the EQ-5D index were associated with the dimensions of anxiety/depression (35.3%) and pain/discomfort (32.9%). The percentage of self-reported problems for the dimensions of usual activities, mobility, and self-care were 19.0, 12.8, and 8.9%, respectively. Our regression analyses indicated that there were statistically significant positive associations between being physically active, monthly household income per capita, and post-secondary education and the EQ-5D index and EQ-VAS score. In contrast, negative associations were found between older age, being married, having a chronic disease, and smoking and the EQ-5D index and EQ-VAS score. A negative association was also found between being uninsured and the EQ-5D index. CONCLUSIONS: Our findings suggest that interventions aiming to improve physical activity, to prevent chronic diseases, and to reduce the smoking rate among adults living in the city of Kermanshah may improve their HRQoL.

Global Prostate Cancer Incidence and Mortality Rates According to the Human Development Index.

BACKGROUND: Prostate cancer (PC) is one of the leading causes of death, especially in developed countries. The human development index (HDI) and its dimensions seem correlated with incidence and mortality rates of PC. This study aimed to assess the association of the specific components of HDI (life expectancy at birth, education, gross national income per 1000 capita, health, and living standards) with burden indicators of PC worldwide. MATERIALS AND METHODS: Information of the incidence and mortality rates of PC was obtained from the GLOBOCAN cancer project in year 2012 and data about the HDI 2013 were obtained from the World Bank database. The correlation between incidence, mortality rates, and the HDI parameters were assessed using STATA software. RESULTS: A significant inequality of PC incidence rates was observed according to concentration indexes=0.25 with 95% CI (0.22, 0.34) and a negative mortality concentration index of -0.04 with 95% CI (-0.09, 0.01) was observed. CONCLUSIONS: A positive significant correlation was detected between the incidence rates of PC and the HDI and its dimensions including life expectancy at birth, education, income, urbanization level and obesity. However, there was a negative significant correlation between the standardized mortality rates and the life expectancy, income and HDI.